Osteoporosis

A fracture of the hip bone in an elderly person can be the proverbial last straw. We saw a friend’s mother go through it all. She used to be petite and frail and a hump (bent spine). One day she fell in the bathroom, broke her hip and became bedridden. Orthopedicians and her children, two of whom were doctors, felt scared to subject the 75 year old to surgery. She therefore lay in bed for 3 long years, fed and bathed by domestic aids. She suffered the extra misery and humiliation of depending on them for the bed pan as she could not make it to the toilet. In spite of all possible care that the family could provide, she developed bed sores. Her recent death was perceived by many as liberation from her painful hopeless state.

Each year, there are an estimated 500,000 spinal fractures, 300,000 hip fractures, 200,000 broken wrists, and 300,000 fractures of other bones.  About 80% of these fractures occur from relatively minor falls or accidents, and are caused by osteoporosis. The stats in India are scary: one of three women above 45 has bones that are fragile and weak ,with 30 million people estimated to be suffering from this condition.

Osteoporosis usually causes no symptom and hence goes unrecognized, till a bone, usually the hip or the spine, cracks or breaks often with very minor trauma or fall. "With every major osteoporosis fracture, the risk of death doubles. Yet it is not taken seriously the world over," says Professor John Allan Eisman, Director, Bone and Mineral Research Programme, Garvan Institute of Medical Research, and Professor of Medicine, University of New South Wales, Sydney.

There are 3 factors that keep bones strong and healthy: adeqaute quantities of calcium, Vitamin D and regular exercise.

Calcium, as we all know, is present in in fish, milk and dairy products. For calcium to be absorbed form the gut and deposited in bones, comes the role of Vitamin D. While adequate exposure to sunshine is considered to ensure abundant supplies, it is paradoxical that 70% Indians are found to be deficeinet in this vitamin despite the hot sun blazing overhead most months of the year. Recent studies have pointed out that affluent Indians, who can and usually do avoid the sun, are more Vit D deficient; manual workers exposed to sunlight rarely are.

The third factor, and perhaps the most crucial, is excercise. The bones of those who excercise regularly seem to remain thick and strong. In such short spans as a month, bones, if not put to adequate use, lose their calcium. This finding explains why  hips and legs become weak and fracture-prone in those who do not walk regularly, why women from affluent homes who travel more in cars and walk little suffer more from osteoporosis, and why the focus on treatment  in the west has moved to regular sessions of dancing or sports for the elderly. Let us then walk the miles before we sleep.

As published in HT City( Hindustan Times) dated 27 March, 2011.